Transvenous lead extraction (TLE) is a key intervention for managing implantable cardiac device complications. While removal is well established in the case of infection, the optimal approach for non-infected, superfluous leads remains debated. New evidence presented at the European Society of Cardiology (ESC) Congress 2025 underscores the long-term risks of lead abandonment.

Researchers performed a systematic review and meta-analysis of seven observational studies including 13,105 patients. Outcomes of TLE were compared between abandoned leads (AL) and functional leads (FL). Results showed that extracting AL was linked to significantly higher in-hospital mortality and major complications (OR 2.51, p=0.0037) as well as increased risk of procedural failure (OR 4.16, p<0.05). Longer dwell times further amplified procedural difficulty and complication rates.

These findings suggest that lead abandonment carries important downstream risks, complicating later extraction procedures and patient outcomes. The study emphasizes the need for individualized decision-making: clinicians must balance the immediate procedural risks of TLE against the potential long-term hazards of abandoning non-infected leads.